HIV Testing -- United States, 1996

Human immunodeficiency virus (HIV) infection is one of the leading causes of morbidity
and mortality in the United States. HIV testing, in conjunction with counseling and other
preventive services, can reduce the risk for HIV infection and appropriately link infected
persons to treatment. To characterize HIV testing by region, state, and sex, CDC analyzed
data from the 1996 Behavioral Risk Factor Surveillance System (BRFSS). This report
summarizes the results of that analysis, which indicate a high degree of variability in
HIV testing throughout the United States.

BRFSS is a state-specific, random-digit-dialed telephone survey of the U.S. population
aged greater than or equal to 18 years. In 1996, all 50 states and the District of
Columbia (DC) participated in BRFSS. The 1996 survey included 14 questions about
HIV/acquired immunodeficiency syndrome (AIDS)-related knowledge and attitudes and
HIV-antibody testing history. The questions were restricted to persons aged less than 65
years, except in California, where the questions were asked of persons aged less than 45
years. In 1996, 97,006 persons responded to these questions (state-specific range:
899-3653). Data were weighted by demographic characteristics and by selection
probabilities. Confidence intervals were calculated using SUDAAN to account for the
complex survey design.

A mean of 42% of persons (range: 26% {South Dakota} to 60% {DC}) answered yes to the
question "Have you ever had your blood tested for HIV?" Persons who answered
"yes" were asked "What was the main reason you had your last blood test for
HIV?" Responses were divided into two categories: those who chose to be tested for
personal or health reasons (i.e., voluntarily tested) (responses included: "just to
find out if infected," "for routine checkup," "doctor referral,"
"sex partner referral," "because of pregnancy," or "other"),
and those who were tested for other reasons (e.g., military induction, insurance, and
employment). A mean of 22% of persons (range: 10% {South Dakota} to 45% {DC}) reported
obtaining HIV-antibody tests for voluntary reasons.

The rate of AIDS cases in 1996 was compared with HIV testing percentages in 1996. In
general, in states where the AIDS rate was high, HIV testing also tended to be high (Figure_1). For example, DC had the highest AIDS rate and the
highest testing percentage; Florida ranked third in both categories. In comparison, rates
of overall testing and voluntary testing were lower in the Midwest, where the AIDS rate is
low.

A mean of 44% of men reported having ever been tested for HIV (range: 28% {South
Dakota} to 62% {DC}) (Table_1). A mean of 40% of women
reported having ever been tested for HIV (range: 23% {North Dakota} to 57% {DC}). In 45
states and DC, a greater percentage of men reported ever being tested for HIV than women.
The states with the greatest difference by sex of ever being tested for HIV were North
Dakota (11%), Hawaii (10%), and New York (9%). The states with the smallest differences
were Alaska, Delaware (both 0.5%), and Texas (0.6%).

A mean of 20% of men reported that their most recent HIV test was voluntary (range: 8%
{South Dakota} to 46% {DC}) (Table_1). A mean of 25% of women
reported that their most recent HIV test was voluntary (range: 12% {North Dakota} to 45%
{DC}). In 49 states, a greater percentage of women reported being voluntarily tested than
men. The sex-specific difference in reports of being voluntarily tested ranged from 0.1%
in New York and Indiana to 13% in California.

Editorial Note

Editorial Note: The findings in this report document a high degree of state-specific
variability in self-reported HIV-antibody tests in the United States. Previous reports
suggest this variability probably represents state-specific differences in such factors as
prevalence of HIV infection and the activities of HIV-prevention and education programs
(1).

The success of a health-promotion program depends on the level of participation of
clients. Although HIV testing and counseling does not affect behavior change similarly
across all population groups, in general, persons who voluntarily receive HIV testing are
more likely to undergo counseling and modify their behaviors than those who receive
testing for other reasons (2). As a result, tracking overall testing rates and voluntary
testing rates can help target health-promotion efforts.

The findings in this report are subject to at least two limitations. First, because
BRFSS excluded persons without telephones, some persons at high risk for HIV infection
probably were excluded. Second, because the BRFSS relies on self-reported data, some bias
is expected.

HIV testing can help reach at-risk persons with counseling and other prevention
services and link infected persons with needed health-care services. General population
surveys, such as BRFSS, provide data to assess the use of HIV testing services across
geographical areas. However, not all persons need to be tested for HIV. CDC recommends HIV
counseling and testing services for persons with specific risk factors for HIV infection
and in specific screening settings (e.g., tissue donation and pregnancy). Prevention
programs should be structured to increase the proportion of at-risk persons who receive
HIV-testing services.

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